Sun Xiaosong, Wei Zhengchao, Luo Yiqiang, Wang Ming
Department of Thyroid-Head & Neck Surgery, Jilin Cancer Hospital, Changchun, People's Republic of China.
Department of Preventive Health Care, Jilin Cancer Hospital, Changchun, People's Republic of China.
Cancer Manag Res. 2025 Mar 20;17:651-659. doi: 10.2147/CMAR.S505730. eCollection 2025.
Thyroid cancer exhibits the highest cervical lymph node metastasis rate (20-50%) among head and neck malignancies, with occult metastasis occurring in 30-80% of papillary carcinoma cases. However, conventional single-modality imaging faces certain challenges: MRI has limited sensitivity for detecting micro-metastases (<2mm), while Doppler ultrasound may overlook metastases in isoechoic lymph nodes. Therefore, it is crucial to evaluate the diagnostic value of combining MRI and CDUS. This study aims to retrospectively analyze the diagnostic value of combining MRI and CDUS blood flow parameters in detecting cervical lymph node metastasis in thyroid cancer and to compare the diagnostic performance with MRI or CDUS alone.
To analyze the evaluation value of combining MRI and color Doppler ultrasound (CDUS) blood flow parameters in detecting cervical lymph node metastasis of thyroid cancer, particularly for occult metastases.
A retrospective analysis was conducted on 263 thyroid cancer patients (June 2022-June 2024). Diagnostic consistency between MRI, CDUS parameters (resistive index, pulsatility index, vascular patterns) and pathology were compared. Multimodal evaluation criteria were established: (1) MRI positive signs (lymph node diameter >8mm, cystic change, enhancement heterogeneity) (2) CDUS thresholds (RI≥0.75, PI≥1.25 with chaotic vascularity).
Among 263 patients, 98 had pathologically confirmed metastases. CDUS showed higher consistency with pathology (Kappa=0.783) than MRI (Kappa=0.645). Combined modality achieved 94.9% sensitivity vs 86.7% (CDUS) and 78.6% (MRI), with accuracy improving from 82.1%/75.3% to 89.4% (P<0.05). Notably, 12/22 occult metastases (≤3mm) were only detected by combined approach.
The synergistic combination leverages MRI's structural characterization and CDUS's hemodynamic sensitivity, effectively overcoming single-modality limitations in detecting micro-metastases. This dual-assessment protocol addresses thyroid cancer's propensity for early lymphatic spread, providing critical preoperative staging guidance.
甲状腺癌在头颈部恶性肿瘤中具有最高的颈部淋巴结转移率（20%-50%），30%-80%的乳头状癌病例存在隐匿性转移。然而，传统的单一模态成像面临一定挑战：MRI检测微转移灶（<2mm）的灵敏度有限，而多普勒超声可能会忽略等回声淋巴结中的转移灶。因此，评估MRI与彩色多普勒超声（CDUS）联合应用的诊断价值至关重要。本研究旨在回顾性分析MRI与CDUS血流参数联合应用在检测甲状腺癌颈部淋巴结转移中的诊断价值，并与单独使用MRI或CDUS的诊断性能进行比较。
分析MRI与彩色多普勒超声（CDUS）血流参数联合应用在检测甲状腺癌颈部淋巴结转移，特别是隐匿性转移中的评估价值。
对263例甲状腺癌患者（2022年6月至2024年6月）进行回顾性分析。比较MRI、CDUS参数（阻力指数、搏动指数、血管形态）与病理结果之间的诊断一致性。建立多模态评估标准：（1）MRI阳性征象（淋巴结直径>8mm、囊性变、强化不均匀）（2）CDUS阈值（RI≥0.75，PI≥1.25且血管形态紊乱）。
263例患者中，98例经病理证实有转移。CDUS与病理结果的一致性（Kappa=0.783）高于MRI（Kappa=0.645）。联合模态的灵敏度达到94.9%，而CDUS为86.7%，MRI为78.6%，准确率从82.1%/75.3%提高到89.4%（P<0.05）。值得注意的是，22例隐匿性转移灶（≤3mm）中有12例仅通过联合方法检测到。
协同联合利用了MRI的结构特征和CDUS的血流动力学敏感性，有效克服了单一模态在检测微转移灶方面的局限性。这种双重评估方案解决了甲状腺癌早期淋巴转移的倾向，提供了关键的术前分期指导。
